If parents are not currently married to each other, please describe the student's legal custody arrangements and which parent the student lives with most of the time. Also describe who primarily deals with school issues such as homework, preparing for tests, and communicating with teachers.

Student's Address *

Student's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Your Address

Your Address

If different than students.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Student's Current School *

Student's Current Grade *

Student's Current School District *

Is Student's Current School the Neighborhood School? *

The school that siblings attend?

Yes

No

Your Home Phone *

Your Home Phone

(###)

###

####

Your Cell Phone *

Your Cell Phone

(###)

###

####

Your Work Phone

Your Work Phone

(###)

###

####

Your Email Address *

Does the Student have Down Syndrome? *

Yes

No

Any other diagnosis that could affect education and/or behavior?

Are you a member of Down Syndrome Association of Central Texas? *

Yes

No

Have you ever had an advocate or an attorney handling any aspect of the student's special education or who has contacted the school/school district on your behalf? *

Yes

No

If yes, please explain.

Have you ever filed a complaint with TEA or other state or federal agency about the student's educational issues, sought mediation with the school district, or asked for a Due Process hearing over an issue with the school disctrict? *

Yes

No

If yes, please explain.

When is the student's next scheduled IEP meeting (ARD)? *

When is the student's next scheduled IEP meeting (ARD)?

MM

DD

YYYY

What is the student's current placement? *

If other, please explain.

What supports, services and modifications does the student currently receive? *

Please select all that apply.

1:1 aide

Aide shared with other students

Modified tests and study guides

Modified classroom tasks and homework

Speech therapy

OT

PT

Positive behavioral supports

Other

If other, please explain.

What problem or issue are you or the student having with the school or school district? *

What do you hope to accomplish by having a legal consultation with DSACT? *

Do you need a spanish translator in the event we can provide legal consultation to you? *

Yes

No

Are you familiar with special education terms such as ARD and IEP? *

Yes

No

Submitting this form to DSACT does not mean your case has been accepted for consultation.

DSACT will notify you by email or by phone, usually within 5-7 days after you have submitted this form, if we can give you a no-charge one-time legal consultation about your special education issue. If we are unable to provide you a legal consultation, it does not mean your problem or issue isn’t important. Whether or not DSACT provides you a legal consultation, we will keep confidential the information you provide on this form. Our consultations generally focus on inclusion/placement in the least restrictive classroom environment and provision of appropriate supports and services, including modifying the curriculum. The consultation’s purpose will be to help you be a better advocate for your student by giving you legal information about your special education issue. DSACT does not provide legal consultations about placement in private schools, preschool services or services after 12th grade. Our services do not include help with mediation, due process hearings or complaints to state or federal agencies. The DSACT attorney does not accompany you to meetings with school staff, including ARD meetings.